"Borderline" Provocations: How NOT to Respond

In my Part I post of November 4, I described how a lot of the difficult behavior of patients with borderline personality disorder (BPD) in their intimate relationships is designed to elicit in the observer one of three reactions: anxious helplessness, anxious guilt, and overt hostility. Furthermore I expressed the view that, even though they will make herculean efforts to induce these reactions, and are very good and finding other folk's vulnerabilities in order to do so, they secretly hope they will fail in their efforts.

(A caveat about this series of posts that I should have included but did not is that the behavioral recommendations I give do NOT necessarily apply to either party in the relationship between an adult with BPD and his or her own parent. Altering that relationship is far more complicated and almost often requires extensive coaching by a knowledgeable therapist).

Every time they succeed in eliciting one of the three reactions, they will do more of whatever it was that worked; every time they fail, they will do less of whatever did not work. They will not give up easily, and if they've known you for a while, if one trick does not work, they will have a whole repertoire of other behaviors from which to choose. They will know how to push all of your buttons in the most effective way possible.

Last, because of the variable intermittent reinforcement schedule, if you only occasionally react in the "wrong" way to them, that is worse than reacting badly to them all the time, because they will try that much harder and longer to elicit the "desired" response. In the post, I indicated that in my next post in the series I would start by saying what not to do.

So let's dispense with that. It's fairly simple, so this will be a relatively short post. In future posts I will suggest counterstrategies for the most typical BPD strategies for eliciting the three responses, and then finally advise readers about what to do in the inevitable event that they slip up - so that the variable intermittent reinforcement schedule does not kick in and all former progress lost.

IMPORTANT CAUTIONS:Please be advised that sticking to this program is extremely difficult, so the services of a therapist who knows about these patterns are usually necessary. Also, this section is designed for adults dealing with BPD adults - over 23 years old, actually.

Without further ado, what not to do:

A. Try to please the unpleasable. If they put you in a damned if you do, damned if you don't position (a double bind), try to do something to please them anyway. If they "yes-but" all of your suggestions for solving any problem they present to you (that is, if they reject any and all offered solutions with a sentence that has the structure, "Yes, I could do that, but...), keep offering more solutions. If they ask you to do something that is clearly impossible, try your best to do it anyway.

B. Make sacrifices for them. Stay up all night talking with them on the phone and trying to reassure them about their latest emotional debacle when you have to go to work the next day. Give them thousands of dollars to help get them out of a financial bind that they themselves had put themselves in with profligate spending and irresponsible behavior.

Drop everything you are doing and rearrange your schedule for an entire day so you can do something for them like right now, even though the chances are 50/50 they will not even be there when you get to their abode - and be sure to cancel any planned activity that you've been looking forward to forever that might conflict with your doing so. Drive a hundred miles out of your way to take them somewhere.

C. Get defensive. Say, in frustrated tones, "You know, I'm only trying to help you" or "Don't you understand that I have other things to do?"

D. Act hostile. Cursing them out is particularly helpful for you in achieving your goal of being a complete failure in their eyes.

E. Act guilty. Because you know down deep you should be able to solve impossible dilemmas, and that their behavior is probably all your fault anyway.

F. Stand there and “take it like a (foolish) man.” Are they slapping you around? Verbally abusing you will a barage of invective? Impugning everything you stand for? Screaming at you? Just stand there and let them. Maybe they'll stop.

G. Return in kind. I knew a psychiatrist who got so upset with the verbal nastiness of his patient that he told her she was a dog and that she should have consulted a veterinarian. See if you can stop the BPD person's pain-seeking behavior by inflicting more pain.

H. Lecture them. Tell them all about how cocaine is harmful, that they should leave an abusive relationship, or that they should not ride their bicycles at midnight through crime-ridden parts of town in a bikini with hundred dollar bills hanging out their bras. After all, they are just too stupid to figure these things out for themselves. They'll tell you they think cocaine is good for them. Argue the point.

I. Try to rescue the help-rejecting complainer. Go to their house to try to take them away from an abusive romantic partner. Let them move in with you rent free. Loan them money that they will never pay back. Try to mediate their disputes with others (trying to physically get in between two fighting adults is particularly important - maybe they'll both start in on YOU). Cuss out the people who they claim have mistreated them. Go ahead, I dare you.

I can't wait to see your recommendations. The "don't do" list is pretty extensive and doesn't leave much room for doing. I suspect the "to do" list will be short, and probably be something like: "run away from them."

Please ignore this person, there are plenty of us BPD out there getting treatment. This person's response is a symptom of their illness. You do not have to deal with a BPD person if you do not want to!! It is YOUR choice!

If you want to???
I have literally run my family and children away from my BPD mother and that hasn't stopped her AT ALL. We've still been stalked, harassed, and abused. We have tried to place restraining orders, have NO CONTACT, and the such, and none of it works. So to say it is a "CHOICE" is very uninformed and not even close to the reality of dealing with someone who is BPD.

BPD women trap men to keep them from abandoning them. For example getting pregnant on purpose. The man has no choice if he wants to be a decent father. No woman with BPD should be left in charge of young children. Please ignore this BPD person.

Do you at all believe that people who suffer from BPD have the capability to recover? Please read:
http://www.psychologytoday.com/blog/both-sides-the-couch/201309/borderline-personality-disorder-the-power-recovery

Absolutely, they can recover, but the psychotherapy is long and difficult.

BPD in my view is not a disease but an adaptation to a highly dysfunctional family of origin. I have devoted much of my life to developing a psychotherapy paradigm to help adults with BPD alter their interactions with their parents, which, when successful, in turn frees them up to stop acting out:

Yeah that sounds good unless a GROUP is involved. BIG DIFFERENCE. Meaning a person has BPD but the group enhances the behavior. BIG DIFFERENCE. Oftentimes if people mind themselves and not others situations don't explode. Now we have a group of people with disabilities attacking another. Address that.

This post is focused at the dyadic level - individual to individual. Group dynamics, however, is IMO at the heart of the disorder known as BPD, so several people are almost always involved, and you are absolutely correct that that makes a big difference.

Don't Try to please them yes and no ….BPD's just want to be validated… its ok to please them using empathy... so if you restate what they are upset about and tell them you can see how they would feel that way "if she treated me like that I'd be mad too.." you will get further.

Don't Try to please them yes and no ….BPD's just want to be validated… its ok to please them using empathy... so if you restate what they are upset about and tell them you can see how they would feel that way "if she treated me like that I'd be mad too.." you will get further.

This is right on. A lot of cutters and anorexics are diagnosed as borderline, even if they don't have symptoms of aggression and impulsive behavior. I think using empathy with such cases is remarkably effective.

I can understand providing this list for people who claim that they have been seduced or manipulated by those with BPD. It give them a reality check and show them that they have chosen to behave in certain ways but I still very much doubt that these behaviours themselves are synonymous with an actual diagnosis of BPD.

I'm very skeptical also of this idea that those of us with BPD are seeking to provoke specific reactions in other people. I believe you are crediting us with too much premeditation. We are first and foremost creatures of impulse. We feel things intensely and that intensity impacts upon those around us. There is no intention behind it just the force of our own existence which is wrongly credited as being deliberate and conscious.

Having BPD is like experiencing grief on a daily basis out of nowhere, for no particular reason. Your head just falls way below your boots at a moments notice and there is no space in society to accommodate this malady. Therapy doesn't teach us good manners or how to respect other people's needs, wishes etc. We know these things. It simply teaches us to recognise our own needs and adapt to a world that does not/ can not.

On the question of intent, you are partly right. Kids in the process of learning to stabilize their parents (in this case, balancing the opposing forces of instability in the parents, guilt and anger) learn to elicit these responses through both trial and error and their own ingenuity. When they are successful, they then began to do this automatically and without any conscious thought - sort of subconsciously if you will, like driving a familiar stretch of road while being preoccupied with something else.

I disagree that the episodes of affective instability that you so nicely describe have no reason. There's always a reason, though often it's not at all obvious.

This is a great comment. When I read the post, I had the impression that it was accusatory. The belief that another person is intentionally trying to inflict specific emotional states within another is not only stretching the imagination here, but is also an incidence of attributing nefarious intent as if one can read the other's mind....a symptomatic part of the cycle of dysfunction in my experience. It is also "crazy making" to insist or reflect through one's behavior that you know the other person's intentions are when you don't. If one is involved with someone with "BPD," it is a good idea to investigate one's own psychology to determine where the hidden reflection of the behavior lies buried within oneself. Also, it is neither realistic, responsible, nor compassionate to vilify a person with a disability, whether it be an addiction, a psychological disorder, or paralysis.

I can agree that if you are dealing with someone who is a bottomless pit of negativity and need that this list is useful. My life has been littered with such people because my poor boundaries and self sacraficial behaviour has invited them in. Therapy for my BPD diangosis has taught me how to live my life for me and not throw it away on people who are incapable of loving or respecting me.

While I have never been attracted to mentally healthy men because I have BPD I do not recognise any of the behaviours you have identified here in myself pre or post treatment. I have always been the rescuer. I have always been the person doing the things that you warn against here and I know of many, many people with an actual BPD diagnosis who are the same.

The post (and the ones that follow in the series) is about provocative behavior that is frequently seen in those with moderate to severe BPD, and of course only applies to those persons that engage in the specific behaviors - and to the people who are attracted to such individuals.

My partner is BPD, not diagnosed by a doctor, but he himself think he is, and I tell him time and again, he treats better the people incapable of loving him or that don't want the best for him, that just use him than his own family and me.

Is very weird. He goes the extra mile for people that treat him like dirt, takes their abuse at work or socially and pretend is all ok and treat them nicely, but he verbally abuse me and make me very stressed with all the points in this article. I told him so and I don't even know anymore how to behave around him, I stopped taking any initiative.

I hope people with BPD would learn to distinguish people that (would) love them and respect them and sometimes do mistakes because they are human (don't want to hut them on purpose) from users and people that don't care about the BPD person, but use them all the time (like asking favors, paying them badly and saying mean things to them).

Maybe if somebody that really loves you and want you good, would be taken for granted or misunderstood and not be able to approach you, but those users and bad people maybe be attracted to you and subconsciously invited to be in your life because of the self-sacrificial behavior? (Watch out for liars, etc, people that pretend they need to be saved/ a savior, my partner always fall for those fake people, sometimes a person that says an ugly truth or sometimes a little brash can be nicer than a "save me" poor me person).

I have BPD. I do not go about my relationships looking to elicit in the observer one of three reactions: anxious helplessness, anxious guilt, and overt hostility. WTF??? I resent that.

I mean come on. That would imply I was like a sociopath with an agenda. I can assure you never in my life have I had an agenda (at least not a conscious one) in my interactions with people.

The fact that you posted this "negativity about BPD" is another subversive attack on a vulnerable population. What, quite frankly, is up with Psychology Today articles and all of their attacks on people who SUFFER with BPD? It makes me sick.

Can someone for once post some positive things about someone that suffers from BPD??? I like the person who said treat them with empathy! We are human beings. How not to treat us, wow why don't you just pretend we are dogs then you can train us how you like.

Thanks for your comment, but if you do not get reactions like these from your intimates, then the post obviously would not apply to you or the people who deal with you.

If, however, you think that a lot of individuals with moderate to severe BPD do not often act like I describe, you'd be incorrect. I've been watching them do it for decades.(And their agenda is often subconscious, BTW).

Why do you think they have such a bad reputation among therapists? Granted, therapists should know better, and know how to handle them, but that's another issue.

Regardless of who we are, our behavior is always about ourselves. For example, a philanthropist does their work because THEY value helping others and derive meaning from it. person who believes in their own superiority will find ample justifications for it and disregard signs that invalidate this belief. So it is for every person. Just so, BPD's behavior has naught to do with another person. This is good to remember because that is the clue to all interpersonal relationships: taking full responsibility for one's actions, reactions, emotions, desires, values, et all.

Interestingly enough, it is those WITH BPD who refuse to see the REALITY of what that actually entails for those around them.

As a daughter of a severe BPD mother, this list is not only accurate, but is only the skin of an incredibly deep, extremely disturbing behavioral condition that is absolutely horrendous to have to interact with, even on the most superficial of bases.

I have a lifetime full of examples, anecdotes, and themes to support all of this and what BPD actually can cause in its victims, those of whom actually are the innocent bystanders of such a sick disorder.

There is no question as to why therapists have dealt with BPD clients in a shocking manner historically and today also unfortunatley. It is because of the countertransference that they experience when dealing with patients they do not and cannot understand.

The tempestuous and terribly painful relationships that people with BPD experience with their therapists/clinicians, comes from the invalidation of their experience as decent and highly empathic people. Dr Blaise Aguirre gives a good lecture on this concern here if you would consider watching it - http://youtu.be/trtt-eiHtXQ

Part of the condition which goes horrendously underreported is that we have heightened empathy. If a clinician/therapist is in denial about this then they will misinterpret it. We also have fantastic insight, not that it enables us to control our brains to regulate our emotions, but we have it nonetheless.

When a patient with BPD is in a room with someone who is a professional, who does not share these empathic and instightful qualities then it is intensely frustrating and I have experienced it myself with my first therapist. The therapist believes they are right and the reason the treatment isn't working is because the patient is trying to elicit some response in them that they believe is unhelpful. It is their professional conceit and not the patients pathology that brings about this dysfunction in the therapeutic relationship.

New methods of treatment such as MBT, TFT and SFT are honing in on this fact and making great strides in effectively and speedily treating BPD. The therapist has to be open minded and willing to listen to what the patient is saying without prejudice. This way there is no need for the patient to bash at the therapists walls of ignorance to demand that their reality be validated.

Now while I gained some benefits from my poorly trained therapist they were slow and painful and when the therapepeutic relationship ended I broke down completely and came the closest I have in my life to suicide. His insistence that I was trying to manipulate him into feeling certain ways made me behave in ways with him that I have never had to with my properly trained SFT therapist or my EMDR therapist.

How I behaved in his room was no comment on my person or indicative of how I behaved outside of treatment with him. What he interpretted as my trying to elicit a response of anxiety, hopelessness and guilt was in actual fact his refusal to accept that his faulty course of treatment was making him feel anxious, hopeless and guilty. His refusal to acknowledge this made me very ill and I daresay he would agree with everything you've written here.

My vote goes to "Danielle Field" for just hitting the nail on the head in understanding BPD and the problems with the therapists that treat them! Finally someone who gets it around here!

And Dr. Allen if someone went so far as to actually try to kill you for your releasing them from the hospital… then maybe the release wasn't such a good idea and you could have shown a little more empathy towards how sick they felt they were if they went so far as to attempt murder…

just saying its usually a good idea that BOTH the patient and the doctor feel comfortable in a patient being released from the hospital… otherwise they might hurt themselves or someone else… and thats what the hospital stay is for.

Yes, of course you're right: I should have asked her what horrors were waiting for her back at home. I know that now; like I said, I almost never get any such problem reactions nowadays.

But you are minimizing the patient's contribution to the problem.

The patient didn't even TRY volunteer ANY information about WHY she wanted to stay, or what she was afraid of. Even if she wasn't certain about it, she could have at least made the effort - but instead, she just acted out.

(I notice you didn't comment about the second patient I mentioned).

Back then, when BPD was quite rare, I had never met anyone, and we weren't trained to expect someone, with no obvious major psychiatric disorder who might WANT to stay in a MENTAL HOSPITAL. Who likes to be in such a place? Thrown in with a bunch of psychotic people? Remember, we knew next to nothing about the condition back then.

With the emphasis by today's CBT therapists on helping patients to suffer with more grace rather than on addressing the family situation that is creating the suffering in the first place, a lot of therapists still know nothing about the condition.

Let me first say, that I applaud the hard work of professionals in trying to help patients with BPD. I believe the biggest problems in therapy lie in not actually understanding what is happening within the patient. Here, for example, the behavior of the patient might be understood (a possible case scenario) in the light of the BPD person's life EXPERIENCE that people are not trustworthy and that by-and-large they have felt tremendously hurt and damaged by others. This can cause one to hold all one's cards to the chest. When one is in a high fear state, the act of revealing what is happening inside feels extremely threatening to the point that one is unable to speak. The breakdown of the minute amount of control that one feels over oneself and one's destiny is threatened. It feels like an extreme violation to be made to reveal one's inner experience. After all, this person has never felt safe with anyone; one can only trust oneself. Just a bit of insight in understanding behavior when looking from the outside.

You're absolutely right about the lack of empathy by many therapists for the conditions that create acting out in patients with BPD. That does not mean, however, that pts with BPD don't act out and make things worse for themselves. As I have stated several times, patients with BPD who do the things I describe in this series of posts really hope that the therapist sees through them.

When I first started out as a therapist, there was NO good information about what creates the condition and no guidelines about how be empathic. That is not the case any more, but many therapists haven't got the message.

I'm sorry if you don't believe this, but retaining empathy was very difficult when, for instance, a patient literally tried to kill me when I told her I was going to discharge her from the hospital. I discussed this and several other such stories in my last book. The very first patient I saw in therapy as a psychiatry resident, back in the heyday of psychoanalysis, spend the first several sessions doing nothing but insulting me for the entire session (She later admitted that she was actually ADMIRING me the whole time she was insulting me, because I didn't throw her out of the office).

Because I now know how to respond to behavior like this, this stuff never happens to me any more. That doesn't mean that patients don't do these kinds of things.

Your theory such as it is seems to suggest that even if those with BPD are not "acting out" then we fundamentally have a problem with trying to make people behave in a certain way, consciously or not. Those therapeutic interventions that work effectively and swiftly are those which are going beyond this anachronistic conception of what BPD is and how it manifests. I'm not buying you or this. You may have more success because of your ability to see the who family as dysfunctional and not just the identified patient but you've got a long way to go in terms of overcoming your misconceptions and prejudices.

Everyone tries to get other people to act in certain ways all the time, not just people with BPD. There's absolutely nothing wrong with that inherently. You seem to be assuming that I am criticizing them.

If their problem isn't with other people, then what IS it with? I know you don't think the problem is just in their heads, but that's the logical conclusion that follows from what you are saying.

When I am feeling overwhelmed by my emotions it makes people around me feel certain ways. There is no intention on my part to make other people feel anything when I am consumed in this way just as there is not intention on the part of someone in any kind of intense pain to try and make another person feel it. What I need in those situations is patience, understanding and the space to feel what I need to feel without other people slapping their own inaccurate interpretations on what they believe I am trying to make them feel.

Now with Schema Focussed Therapy the therapist recognises when a schema has been activated and, instead of questioning what it is that the patient is trying to make the therapist feel they ask the patient to explain what it is they are feeling. Even though I understand that the intensity of my emotions is incredibly difficult for other people to deal with having a therapeutic relationship with someone who is capable of sitting back and helping me understand what it is I am feeling without interpretting it is invaluable. We are making progress precisely because he doesn't assume he knows what I am feeling.

What you are doing is saying that in your experience of dealing with people who have BPD you recognise what they are trying to make you feel. This kind of therapy is not effective with people who have BPD. Like I said you are probably having some success in terms of validating their experiences in their family life but you harbour anachronistic views about interpretting your patients intentions conscious or otherwise.

Therapy for BPD has to start first and foremost with the therapist helping the patient to be able to express to the therapist what they feel so that the therapist can correctly understand this. In a therapy session I will go through numerous schemas which may look the same and feel the same to an untrained therapist but each one has a distinct character and the more I understand about them the better I can equip my therapist to help me to overcome them.

My therapist is constantly asking me "Have I got this right?" and sometimes he hasn't. We sit with an emotion I am feeling for a whole session sometimes just so that he can accurately understand it. If he was to do what you are doing by assuming that you have a professional position which qualifies you to know above and beyond your BPD patients own experience what it is they are trying to do you will make them ill.

The example of your client who tried to kill you and then went on to kill herself is a particularly prejudiced and blinkered example of your interpretation of "acting out". In what universe is someone being so desperate at your inability to understand or help them with their problems that they are drawn to the conclusion that death is the only answer a good example of a BPD patient acting out? I wanted to kill myself after my therapeutic relationship ended. Your guilt at that experience has significantly coloured your ability to truly see BPD for what it really is.

I know my patients try - at times - to induce feelings in others because they tell me so themselves. It can be hard for them to deny it after I empathically point out the evidence - which comes entirely from other things they've said themselves during the course of therapy. (I keep track. Thank goodness for notes).

I did not say that everything they ever do is designed for this purpose, nor that they are going for the three reactions I discussed in the post all the time, so please don't accuse me of that. The example you give of being consumed by pain and sitting there quietly may or may not be designed with this purpose. The clue is when they do such things in a highly provocative manner. If you've never done that, great. I believe you.

And of course I check with my patients about ANY hypothesis about them and the way they are feeling that I am entertaining. BTW, the patient who tried to kill me did not go on to suicide. Also, I know the founder of schema therapy, Jeff Young, personally and we are in substantial agreement about far, far more things than those on which we don't completely agree.

Feel free to have the last word on this issue. I've said about all I can say.

The problem is you have all these people with supposed BPD responding to your comments and article and I very highly doubt that someone WITH the disorder can even vaguely begin to see their actions as transparently as those around them, witnessing every instance.
It abhors me to see the constant denial from BPDs and "BPDs" on here when it is a sickness that feeds off creating victims of those around them.
You have NAILED every point and I have living proof that backs it.
You and others with whom a BPD interacts with has a vantage point that no BPD or "BPD" could ever recognize. And denial of that is issue numero uno as to why BPD is such a horrible disease with limited recovery.

Dr. Allen, I have a partner suspected BPD, he slowly himself saw he probably have it, and I know he told me he sometimes do it consciously sometimes not. Maybe the BPD person above doesn't have high self-awareness during the events and just do it subconsciously or so impulsively that he doesn't consider intentional?

Maybe that is what they mean? I know I asked my partner why he does that and said to test me (if I care/love him) or to revenge, but usually he gets more hurt than I do, and I asked "but why do you do it if you get hurt too by the emotional drama you create? Does emotional provocation/revenge makes you feel better?"

He admitted that it doesn't (sometimes he stays awake and sleeps little and have to go to work because of petty emotional dramas before bed), but that he does it without even thinking, is an impulse hard to stop when it starts.

He is even thinking of studying psychology, do you think a person with BPD can be help her/himself by studying psychology in a formal education context? Or can make them more provocative/manipulative/confused?

I can't comment on specific cases like yours or give any usable advice without having evaluated them in detail myself in person.

As a generalization, most people who do the same self-defeating things over and again are doing so on automatic pilot and without thought most of the time, but at some point they have thought about it. They have elected to sacrifice themselves in order to solve a problem in their family of origin, the nature of which I outline on my post about the family dynamics of patients with BPD and my two posts on their parents.

They also have a strong tendency to recruit other to enable their self destructive behavior, which puts people who care about them into a damned-if-you-do and damned-if -you- don't position. People who put up with it and keep coming back for more are generally doing so in order to solve a difficult problem in their own family of origin.

While people can learn about their family dynamics and learn about why everybody reacts the way they do, and this can help them change their behavior, in general they need help in dealing with their families from a knowledgeable therapist.

Listen, Dr Allen, I have met people who have BPD who also happen to be provocative people. There having BPD does not determine their being provocative people. I have met people who project all their faults onto other people who also have BPD and similarly I have met people who do not have BPD who do the same. What you are doing here is making a connection between a person's provocative behaviour and their BPD diagnosis and it is this that I am challenging as it feeds stigma and encourages the mob to go round diagnosing provocative behaviour as being indicative of BPD.

When you have a personality disorder everything you do, every human quality you have is reduced to a manifestation of your personality disorder which is intensely invalidating and inhibits recovery. Of course projection, transference, manipulation and provocative behaviour are human qualities, not the nicest ones, but human all the same. When people with BPD exhibit these qualities it is not because they are human but because they are "borderline". Why are you having so much difficulty in recognising this point?

In future when you are discussing negative human qualities in reference to your patients who happen to have a diagnosis of BPD then please, as an experiment, try replacing the word BPD with black person and see for yourself just how provocative your theories are. For example "When dealing with black patients it is important to understand that their provocative behaviour is caused by their unconscious desire to elicit in you a response of hopelessness, anxiety or guilt." I hope now you can see why it is offensive to be constructing theories about the specific nature of provocation as it relates to your patients with a BPD diagnosis.

Provocation is human behaviour. When anybody engages in it they are doing so for specific reasons to elicit a response in the person they are provocating. You did so yourself just now with your "Feel free to have the last word" comment. You made me feel anxious, hopeless and guilty. I almost decided not to respond based on your provocation but after a nights sleep I realised that this issue was too important to allow your manipulative behaviour to control this debate simply because you are attached to believing that people with BPD are peculiarly provocative.

I didn't mean to provoke you, but I've addressed these points in several posts as well as the comments section of those posts, and of course I should not have expected that you'd have read all of them.

Sorry, but ethnicity and personality disorders is not a valid analogy. The definition of a personality disorder: "Personality disorders are characterised by enduring maladaptive PATTERNS of behavior, cognition and inner experience, exhibited across many contexts and deviating markedly from those accepted by the individual's culture. These patterns develop early, are inflexible and are associated with significant distress or disability.

"Exhibited across many contexts" does NOT mean ALL contexts. In fact, I know, unlike many therapists, that the behaviors of a person with any p.d. are quite context specific, although to several seemingly different contexts.

I agree with you about "human" qualities. The problem behaviors that characterize BPD are exhibited at one time or another by all of us. That's why I do not think it's a "disease," but an adaptation to a very human family dilemma.

A specifc TYPE of provocative behavior (there are a lot of other types, so "provocativeness" in general is not the issue) is part of the maladaptive behavior that defines the disorder.

Do an anonymous survey of therapists asking about whether or not a large majority of their patients (but not ALL) with BPD exhibit the type of behavior I'm talking about on a frequent basis, and you'll have your answer. I've talked to a LOT of therapists, as well as most of the American academics who study BPD. I've also treated them in very comprehensive, long term therapy where I ask about a lot of areas of their lives that DBT therapists tend to ignore.

Patient's with BPD also characteristically "split" (although they really don't believe that people are all good or all bad, but they often act as if they did). We're talking about behavior, not skin color.

Just as an aside, either of the following is fallacious when it comes to taking responsibilities for one's interpersonal problems: "It's all my fault" and "I had nothing to do with it."

Some of us, who interact with a BDP relative (32 yr old daughter) need to hear what not to do in response to these behaviors. My wife and I just got horribly treated yesterday. She works for us, and refused to do her job, screamed at everyone, removed us from her life for awhile etc... More than likely because someone stole her anxiety men's, and she couldn't get more till Monday. But my wife cried , and shook , most of yesterday. She needs to block my daughters texts, and shake off all the mean comments. We need to hear what not to do. She will calm down soon. Her ex husband knew this well. She needs to have a few days when she does this. But WE NEED to have peace as well. Good suggestions! Maybe she will try her 5th or 6th therapist soon. Maybe someone with The schema? Therapy. I hope they are closing in on help for her. It seems to me it is going to take a former BDP patient to find a cure. They have so much insight, and sensitivity to emotions. They just have trouble because they are overwhelmed by them.

And your profession is still propogating that stigma. Only those that listen hear. Those like yourself who still cling to this conception that BPD is more than an emotional regulatory disorder keep the fires of stigma alive.

We are damaged, yes. We have special needs that require specific methods of rearing in order for us to flourish as they highly sensitive and empathic people that we are. We are not like everybody else and those of us that are lucky enough to have exceptional parents go on to become highly sensitive but incredibly strong individuals.

Those of us who are not so lucky experience an incredibly invalidting life. We have no frame of reference for how to express and develop our emotions. What you and others perceive to be pathological tendencies are simply what anyone would experience if they lived a life of intense frustration and invalidation.

You do not get what BPD is. If you did you wouldn't be contributing to stigma the way you are in this article and in the comments here. You're not alone. Perry Hoffman president of the NEABPD propogates stigma herself so why shouldn't you? We need help to learn how to do something that most people never have to learn how to do - to become healthy hypersensitive individuals. You are not a hypersensitive individual.

You're a regular Joe with an ego to match. I don't need to read all your preceding materials if they have done nothing but bring you to the conclusions you've drawn here. Like so many other therapists you are part of the problem, not the solution. I have no need to read another word you have to say on the matter.

I so thoroughly identify with the many 'do not's' that you have listed. I have a wife the may suffer from BPD- comparing my experiences with her to the information identifying BPD leads me to this finding. I have done many of the do not's and have had no success. Zero! Zilch! And dealing with her has resulted in my becoming someone I do not like. In fact, my own psychologist has advised me to not do certain things; the same things you have listed in your article.

Thank you for reminding me of the foolish things I should have never done.

In the anonymous post above we have a person who has a provocative wife that he suspects has BPD based on his analysis of her external behaviour. Now while I have no reason to doubt she is a provocative/argumentative woman I am suspicious about the fact that it is her partner and not herself that suspects she has BPD.

If his wife has BPD she will be experiencing intense emotional pain that she will likely be seeking help for herself. But now that the anonymous poster above has read here that by practicing your list of how best to deal with a provocative person generally and linked that to his suspicion that his wife has BPD you have added fuel to this already dangerous fire.

Like I said before this list of don'ts that you have posted here is relevant to anyone dealing with a provocative person and are not in anyway specific to dealing with a person who suffers from BPD. If you continue to post articles focusing on negative human qualities which exist across the entire human population and link them specifically to people with BPD who happen to share these human traits you will be adding to the stigma surrounding the disorder.

sorry but I don't see how it is effective to post what "not to do" over what "to do"… it is much more helpful to post your theory of what to do then perhaps you wouldn't have to backtrack and "clarify" yourself on what you didn't mean so much

Reading the list, I was deciding whether to continue in the series or not.

It is a few years later, but I am going to continue and for this ONE reason:

Your interactions with Danielle Field have demonstrated that you actually DO know how to deal with borderline personality disordered sufferers/patients.

The list was very difficult to apply in the case of the patient/sufferer I have to deal with as an adult; because she is not flamboyant or outgoing; she is very intelligent and charming and certainly doesn't self-harm nor threaten suicide. She presents as a doting mother and she is very productive and efficient in public, where she serves as a community leader. But, she is also very manipulative and cunning in certain contexts. I'm lucky enough to be married to her ex-husband, and I'm step-mom to their adorable 3 year old daughter, together.

I understand that she is hurting, is maladaptive, is the apparent patient (apologies if the terminology is wrong) but what I haven't been able to find in literature is evidence of how to deal with her as you have with Danielle Field.

When I read the comments, I was initially very open to the idea that her experience would actually prove you wrong! I just felt that it would be fair to hear a patient's perspective. The minute you were able to stand your ground, you were degraded and became a mere man "with an ego to boot". At another point, you were "aiding and abetting a ficticious suicide" and then later you were "stigmatizing" people and then you were "invlidating" Danielle Fields and YOU made HER feel "anxious, hopeless and guilty". She was adamant that at her best, she feels hypersensitive and has NO magical powers of succeeding in making anyone feel anything, and especially convinced of her conviction that she HOLDS no agenda to change anyone's mind. Ever. About anything.

At the end, Danielle Field was happy for you to quote her "Puh-leeeze" composition, because you were still a "good therapist" (and that was also the same point at which she claimed to have followed your postings from before.) But, when she felt offended by your refusing to compare race with personality disorders, she then said that "ALL" your articles were perjorative against patients. Nevermind that you were at a certain point worth following so intently for the great progress you made in identifying the family dynamics of BPD. It's a shame you are not knowledgable about BPD at all, anymore. Much like the President of the NEABPD.

It likely isn't conscious, but Danielle Field did all of project, devalue, idolize, become helpless, claim victim, cry foul, and SPLIT. Then she really got upset when a man whose wife may have BPD shared; because she perceived his comments about his own marriage to be directed at her. An inaccurate perception of events, all hallmarks of BPD. The comments section, alone, is worth reading.

I am now going to read the rest of this series and then onto Amazon. FINALLY, someone who knows how waif-like and hermit and high-functioning sufferers always twist and manipulate to make people have to feel and agree to conform to their world view.

I'm terribly sorry to those who live what they see as being a life of invalidation, belittlement and misunderstanding. I also feel great compassion for those who are in relationships with them who are sometimes made to feel guilty for acknowledging that bpd sufferers do in fact create much of the chaos in their interpersonal relationships.

Danielle Field, I applaud you for comparative civility during your exchanges; I just feel that there is a missing objectivity that is really experienced with those whom this article and series is directed. I empathise that you often feel misunderstood. Really, people TRY and understand, but the very nature of BDP makes this disorder more than emotional regulation by sheer greater will. You are not going out of your way to manipulate, but the world is not going out of our way to injure of fail you. There are cognitive components not addressed by DBT that need to be considered for average people/spouses/colleagues etc, and therapists provide those here. I hope that you remain committed to alleviating the great suffering of patients/sufferers of BPD like yourself; but I have to applaud Dr Allen for his stance. He is NOT just an ignorant egomaniac or someone personally (or more generally) attacking you or making false claims simply because he doesn't completely agree with you.

Based on articles like this, three of my past romantic partners "diagnosed" me with BPD. I had not been diagnosed by my own psychologist, though he admits I have "tendencies" and he may be withholding the diagnosis because I've reacted so strongly against it. All of these partners actually did resent me, and I read that resentment on their faces (we are very, very good at reading facial expressions--probably because many BPD people often grew up with alcoholic or unpredictable caregivers, which made accurate assessments of subtle emotional shifts crucial to our childhood survival). So I would read the cues in my partners (resentment, a concealed truth, FEAR) and ask and poke and pry them to get them to verbalize what they were feeling. And that aggressive provocation was a sign of my "BPD." So I ended up being dragged to the doctor by these partners, and they got to play victims. Because apparently BPD people aren't permitted the terms "lovers" or "spouses" or "friends"--just "victims." It's insane. We are not psychopaths. We care a lot about what others think of us, and actually we care a lot about others generally. We care too much, and careless people get uncomfortable with that.

Look: our brains are wired to react abnormally to seeing fear or hostility in the face of the other. So if our partners OR our therapists are fearful, resentful, etc. about treating us we respond to that emotionally. We read our doctors as well as our romantic partners, and usually detect the most subtle resentment, fear or arrogance in the faces of our doctors. So the tail spin begins.

Just treat BPD cases as though we are aliens from some other planet that's better than this one. We just don't understand why people conceal their emotions, how we can detect these concealed emotions in others, or how to control our own intensely empathetic responses. If someone is angry in the room, we'll feel it (even if they're hiding their anger). Same with fear. We pick up on the emotional soup around us and make it manifest. And then we get blamed, labelled and condemned with this awful diagnosis.

Um... you are not a mind reader, as much as you want to believe it. Stop projecting your crap onto other people. Kbaithnx

Danielle, thanks for standing up for yourself and for the rest of us.

Based on articles like this, three of my past romantic partners "diagnosed" me with BPD. I had not been diagnosed by my own psychologist, though he admits I have "tendencies" and he may be withholding the diagnosis because I've reacted so strongly against it. All of these partners actually did resent me, and I read that resentment on their faces (we are very, very good at reading facial expressions--probably because many BPD people often grew up with alcoholic or unpredictable caregivers, which made accurate assessments of subtle emotional shifts crucial to our childhood survival). So I would read the cues in my partners (resentment, a concealed truth, FEAR) and ask and poke and pry them to get them to verbalize what they were feeling. And that aggressive provocation was a sign of my "BPD." So I ended up being dragged to the doctor by these partners, and they got to play victims. Because apparently BPD people aren't permitted the terms "lovers" or "spouses" or "friends"--just "victims." It's insane. We are not psychopaths. We care a lot about what others think of us, and actually we care a lot about others generally. We care too much, and careless people get uncomfortable with that.

Look: our brains are wired to react abnormally to seeing fear or hostility in the face of the other. So if our partners OR our therapists are fearful, resentful, etc. about treating us we respond to that emotionally. We read our doctors as well as our romantic partners, and usually detect the most subtle resentment, fear or arrogance in the faces of our doctors. So the tail spin begins.

Just treat BPD cases as though we are aliens from some other planet that's better than this one. We just don't understand why people conceal their emotions, how we can detect these concealed emotions in others, or how to control our own intensely empathetic responses. If someone is angry in the room, we'll feel it (even if they're hiding their anger). Same with fear. We pick up on the emotional soup around us and make it manifest. And then we get blamed, labelled and condemned with this awful diagnosis.

Um... you are not a mind reader, as much as you want to believe it. Stop projecting your crap onto other people. Kbaithnx

Danielle, thanks for standing up for yourself and for the rest of us.

Based on articles like this, three of my past romantic partners "diagnosed" me with BPD. I had not been diagnosed by my own psychologist, though he admits I have "tendencies" and he may be withholding the diagnosis because I've reacted so strongly against it. All of these partners actually did resent me, and I read that resentment on their faces (we are very, very good at reading facial expressions--probably because many BPD people often grew up with alcoholic or unpredictable caregivers, which made accurate assessments of subtle emotional shifts crucial to our childhood survival). So I would read the cues in my partners (resentment, a concealed truth, FEAR) and ask and poke and pry them to get them to verbalize what they were feeling. And that aggressive provocation was a sign of my "BPD." So I ended up being dragged to the doctor by these partners, and they got to play victims. Because apparently BPD people aren't permitted the terms "lovers" or "spouses" or "friends"--just "victims." It's insane. We are not psychopaths. We care a lot about what others think of us, and actually we care a lot about others generally. We care too much, and careless people get uncomfortable with that.

Look: our brains are wired to react abnormally to seeing fear or hostility in the face of the other. So if our partners OR our therapists are fearful, resentful, etc. about treating us we respond to that emotionally. We read our doctors as well as our romantic partners, and usually detect the most subtle resentment, fear or arrogance in the faces of our doctors. So the tail spin begins.

Just treat BPD cases as though we are aliens from some other planet that's better than this one. We just don't understand why people conceal their emotions, how we can detect these concealed emotions in others, or how to control our own intensely empathetic responses. If someone is angry in the room, we'll feel it (even if they're hiding their anger). Same with fear. We pick up on the emotional soup around us and make it manifest. And then we get blamed, labelled and condemned with this awful diagnosis.

Sorry, just had to throw this in.

By the way, I have never been diagnosed with BPD by a doctor. I was diagnosed by romantic partners. My mother was diagnosed with BPD by a doctor, and yes, she was very destructive. That's a matter of moral choice. But growing up with her I do feel that she was sensitive to other peoples' "buttons" and facial expressions, and that she used that destructively. I do believe it's possible to inherit the genetic predisposition to interpersonal sensitivity but what we do with that is a matter of choice, and many BPDs (like many normal people) just don't have a whole lot of character. I don't know if you've ever had any real intimate experience with a DIAGNOSED borderline or if you're just angry at some ex of yours. Talk to some real survivors. Talk to some people who have it in there genetic background, talk to some abuse victims or some people who were raised by certified BPDs. I have ambivalence toward her, and therefore toward myself, and looking at her I see her as condition as a curse and a potential gift, a gift she used unwisely and that I pray I do not use unwisely. You obviously don't have this condition in your family, do you?